US20080243120A1 - Bipolar forceps having monopolar extension - Google Patents

Abstract

An endoscopic forceps for treating tissue includes a housing having a shaft affixed thereto which has first and second jaw members attached to a distal end thereof. The forceps also includes an actuator for moving jaw members relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween. Each of the jaw members is connected to a source of electrosurgical energy such that the jaw members are selectively capable of operating in a bipolar mode which enables the jaw members to conduct bipolar energy through tissue held therebetween to treat tissue. The forceps also includes a monopolar element housed within the first jaw member which is selectively movable from a first position within the first jaw member to a second position distal to the first jaw member. The monopolar element is connected to the source of electrosurgical energy and is selectively activateable independent of the bipolar mode.

Description

CROSS REFERENCE TO RELATED APPLICATION
• This application is a divisional of U.S. patent application Ser. No. 10/988,950 entitled “BIPOLAR FORCEPS HAVING MONOPOLAR EXTENSION” filed Nov. 15, 2004 by Lawes et al. which claims the benefit of priority to U.S. Provisional Application Ser. No. 60/520,579 file on Nov. 17, 2003 by Lawes et al. Entitled “BIPOLAR FORCEPS HAVING MONOPOLAR EXTENSION” the entire contents of both of which being incorporated by reference herein.
BACKGROUND
• The present disclosure relates to an electrosurgical forceps and more particularly, the present disclosure relates to an endoscopic bipolar electrosurgical forceps for coagulating, sealing and/or cutting tissue having a selectively energizable and/or extendable monopolar extension for enhanced electrosurgical effect.
TECHNICAL FIELD
• Electrosurgical forceps utilize both mechanical clamping action and electrical energy to effect hemostasis by heating the tissue and blood vessels to coagulate, cauterize and/or seal tissue. As an alternative to open forceps for use with open surgical procedures, many modern surgeons use endoscopes and endoscopic instruments for remotely accessing organs through smaller, puncture-like incisions. As a direct result thereof, patients tend to benefit from less scarring and reduced healing time.
• Endoscopic instruments are inserted into the patient through a cannula, or port, which has been made with a trocar. Typical sizes for cannulas range from three millimeters to twelve millimeters. Smaller cannulas are usually preferred, which, as can be appreciated, ultimately presents a design challenge to instrument manufacturers who must find ways to make endoscopic instruments that fit through the smaller cannulas.
• Many endoscopic surgical procedures require cutting or ligating blood vessels or vascular tissue. Due to the inherent spatial considerations of the surgical cavity, surgeons often have difficulty suturing vessels or performing other traditional methods of controlling bleeding, e.g., clamping and/or tying-off transected blood vessels. By utilizing an electrosurgical scissors, the surgeon may cut tissue during a given surgical procedure utilizing a combination of mechanical cutting action and electrosurgical cutting. By utilizing an endoscopic electrosurgical forceps, a surgeon can cauterize, coagulate/desiccate and/or simply reduce or slow bleeding simply by controlling the intensity, frequency and duration of the electrosurgical energy applied through the jaw members to the tissue.
• For treating larger vessels, a surgeon may opt to seal the tissue or vessel. Tissue sealing is fundamentally different than simply coagulating or cauterizing vessels. For the purposes herein, “coagulation” is defined as a process of desiccating tissue wherein the tissue cells are ruptured and dried. “Vessel sealing” or “tissue sealing” is defined as the process of liquefying the collagen in the tissue so that it reforms into a fused mass with limited demarcation between adjacent tissue structures. In order to effectively seal larger vessels (or tissue) two predominant mechanical parameters must be accurately controlled—the pressure applied to the vessel (tissue) preferably about 3 kg/cm²to about 16 kg/cm²and the gap distance between the electrodes preferably about 0.001 inches to about 0.006 inches. Several examples of endoscopic vessel sealing instruments are disclosed in commonly-owned U.S. patent application Ser. Nos. 10/116,944, 10/179,863, 10/369,894 and 10/180,926 and PCT/US01/11340 the entire contents of all of which are hereby incorporated by reference herein.
• Generally, the electrical configuration of electrosurgical forceps can be categorized in two classifications: 1) monopolar electrosurgical forceps; and 2) bipolar electrosurgical forceps. Monopolar forceps utilize one active electrode associated with the clamping end effector and a remote patient return electrode or pad which is attached externally to the patient. When the electrosurgical energy is applied, the energy travels from the active electrode, to the surgical site, through the patient and to the return electrode.
• Bipolar electrosurgical forceps utilize two generally opposing electrodes which are disposed on the inner opposing surfaces of end effectors and which are both electrically coupled to an electrosurgical generator. Each electrode is charged to a different electric potential. Since tissue is a conductor of electrical energy, when the effectors are utilized to grasp, seal or cut tissue therebetween, the electrical energy can be selectively transferred through the tissue.
• One of the inherent disadvantages to utilizing a bipolar endoscopic forceps for cauterizing, coagulating cutting or sealing vessels and other tissues is the inability of the bipolar forceps to match the benefits or advantages of monopolar instruments (i.e., monopolar instruments have the ability to move through avascular tissue and dissect through narrow tissue planes) necessitating the need for the surgeon to replace the bipolar forceps during surgery to reap the benefits of using the monopolar instrument for certain applications. Likewise, during some monopolar endoscopic applications it may be advantageous to replace the monopolar instrument with a bipolar forceps, e.g., for sealing large tissue structures. For example, during a cholecystectomy the gallbladder is dissected from the liver which would typically entail using an endoscopic monopolar instrument, e.g., electrosurgical blade, electrosurgical pencil, loop electrode, etc. However, during the cholecystectomy procedure there may also be a need to seal the cystic duct or cystic artery which may require a bipolar vessel sealing instrument necessitating the need to replace the monopolar instrument. The surgeon may need to repeatedly remove the monopolar instrument from the operating cavity to utilize the bipolar instrument and vice versa.
• Thus there exists a need to develop an instrument which can combine the benefits of both monopolar and bipolar operation thereby reducing the need for the surgeon to substitute instruments during surgical certain procedures.
SUMMARY
• The present disclosure relates to an endoscopic forceps for treating tissue and includes a housing having a shaft affixed thereto and first and second jaw members attached to a distal end of the shaft. The forceps also includes an actuator for moving jaw members relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween. A source of electrosurgical energy is connected to each jaw member such that the jaw members are selectively capable of operating in a bipolar mode which enables the jaw members to conduct bipolar energy through tissue held therebetween to treat tissue. The forceps also includes a monopolar element housed within at least the first jaw member which is selectively movable from a first position within the first jaw member to a second position distal to the first jaw member. The monopolar element is connected to the source of electrosurgical energy and is selectively activateable independent of the jaw members.
• In one embodiment according to the present disclosure, the forceps includes a knife which is selectively moveable within a knife channel defined within at least one of the first and second jaw members to cut tissue disposed between the first and second jaw members. Advantageously, a knife actuator allows a user to selectively move the knife to cut tissue disposed between the jaw members. The source of electrosurgical energy carries electrical potentials to each respective jaw member such that the jaw members are capable of conducting bipolar energy through tissue held therebetween to effect a tissue seal.
• Advantageously, the knife is designed to initially cut tissue disposed between the first and second jaw members and subsequently extend distally from the jaw members to treat tissue in a monopolar fashion. Preferably, the forceps includes a safety (e.g. a safety circuit or mechanical safety element) which only allows electrical activation of the knife (or monopolar element) when the knife (or monopolar element) is extended from the distal ends of the jaw members. The safety may also deactivate the jaw members through circuitry or utilizing a mechanical safety element.
• In one embodiment, the first jaw member and the second jaw member each include an elongated slot which runs in opposition substantially along the respective lengths thereof such that the two opposing elongated slots form the knife channel for reciprocating the knife to divide tissue disposed between the two jaw members.
• In another embodiment, the forceps is a vessel sealing forceps and at least one of the jaw members includes at least one non-conductive stop member disposed thereon which controls the distance between the first and second jaw members when tissue is held therebetween. Advantageously, the stop member(s) maintains a gap distance of about 0.001 inches to about 0.006 inches between the jaw members when tissue is compressed between the jaw members.
• In yet another embodiment according to the present disclosure, the forceps includes an actuator which operates to both move the knife to cut tissue disposed between jaw members and to extend the knife or a separate monopolar element from the first position within the first jaw member to the second position distal to the first jaw member. In still yet another embodiment according to the present disclosure, the forceps includes an actuator which operates to both move the jaw members relative to one another from the first to second positions to grasp tissue therebetween and to extend the monopolar element from the first position within the first jaw member to the second position distal to the first jaw member.
• In another embodiment according to the present disclosure, a first actuator may be designed to operate the jaw members for grasping tissue and a second actuator may be included which operates to extend the monopolar element from the first position within the first jaw member to the second position distal to the first jaw member.
• The present disclosure also relates to an endoscopic forceps which includes a housing having a shaft affixed thereto and first and second jaw members attached to a distal end of the shaft. The first jaw member is configured to extend distally relative to the second jaw member. A actuator is includes for moving jaw members relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween. The jaw members are connected to a source of electrosurgical energy such that the jaw members are selectively capable of operating in a bipolar mode which enables the jaw members to conduct bipolar energy through tissue held therebetween.
• The forceps also includes a control switch which, upon selective activation, deactivates the second jaw member and activates the first jaw member with a first electrical potential. At relatively the same time, the control switch also activates a return electrode or return pad with a different electrical potential which is placed adjacent to the patient to enable the first jaw member to selectively treat tissue in a monopolar fashion. Preferably, a safety is included which limits electrical activation of the control switch to when the jaw members are disposed in the second position.
• The present disclosure also relates to an endoscopic forceps which includes a housing having a shaft affixed thereto. The shaft includes first and second jaw members attached to a distal end thereof. Preferably, the first and second jaw members each include a tapered or elongated distal end. The forceps also includes an actuator for moving jaw members relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween. A source of electrosurgical energy is connected to each jaw member such that the jaw members are selectively capable of operating in a bipolar mode which enables the jaw members to conduct bipolar energy through tissue held therebetween.
• A control switch is also included which, upon selective activation thereof, activates the first jaw member and the second jaw member with a first electrical potential and activates a return electrode with a different electrical potential. The return electrode is preferably placed adjacent to the patient which enables the first and second jaw members to selectively treat tissue in a monopolar fashion. Preferably, the forceps includes a safety which only allows electrical activation of the control switch when the jaw members are disposed in the second position.
• In another embodiment of the present disclosure, the actuator is selectively lockable to maintain a closure pressure in the range of about 3 kg/cm²to about 16 kg/cm²and, preferably, about 7 kg/cm²to about 13 kg/cm²between the jaw members which is advantageous in producing effective and reliable tissue seals. In yet another embodiment, the forceps may also include a rotating assembly for rotating the jaw members about a longitudinal axis defined through the shaft. Advantageously, the forceps includes a unilateral jaw assembly, i.e., the first jaw member is movable relative to the second jaw member and the second jaw member is substantially fixed. Alternatively, the forceps may include a bilateral jaw assembly, i.e., both jaw members move relative to one another.
• Preferably, a spring is included with the actuator or drive assembly to facilitate actuation of the movable handle and to assure the closure force is maintained within a working range of about 3 kg/cm²to about 16 kg/cm².
• The present disclosure also relates to a method for treating tissue with electrosurgical energy from an electrosurgical generator which includes the steps of: providing an endoscopic forceps including a housing having a shaft affixed thereto. The shaft includes first and second jaw members attached to a distal end thereof. An actuator is included for moving jaw members relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween. A monopolar element is also included which is housed within at least the first jaw member and selectively movable from a first position within the first jaw member to a second position distal to the first jaw member. A return electrode is provided and placed in contact with patient tissue.
• The method also includes the steps of: connecting to each jaw member, the monopolar element and the return electrode to the electrosurgical generator; grasping tissue between the jaw members; selectively activating the jaw members to treat tissue disposed between the jaw members in a bipolar fashion; and selectively activating the monopolar element and the return electrode independent of the jaw members to treat tissue in a monopolar fashion.
• Preferably, after the step of selectively activating the jaw members to treat tissue, the method includes the step of: extending the monopolar element from the distal end of the jaw members. Advantageously, the step of selectively activating the monopolar element includes deactivating the jaw members.
• After the step of selectively activating the jaw members to treat tissue, the method may include the step of: releasing the tissue from the jaw members.
BRIEF DESCRIPTION OF THE DRAWINGS
• Various embodiments of the subject instrument are described herein with reference to the drawings wherein:
• FIG. 1A is a side view of an endoscopic forceps showing a housing, a shaft, an end effector assembly and a trigger assembly in a first position according to the present disclosure;
• FIG. 1B is an enlarged, cross section taken alongline1B-1B ofFIG. 1A;
• FIG. 1C is an enlarged, side view of the trigger assembly ofFIG. 1A;
• FIG. 1D is an enlarged, side view of the embodiment of an end effector assembly ofFIG. 1A showing relative extension of a monopolar element from a distal end of the end effector assembly;
• FIG. 2 is a side view of the trigger assembly is a second position for advancing a knife within the end effector assembly;
• FIG. 3 is a side view of the trigger assembly in a third position for extending a monopolar element from a distal end of the end effector assembly;
• FIG. 4 is a side view of an alternate embodiment of the present invention showing a second actuator advancing the monopolar element relative to the distal end of the end effector assembly;
• FIG. 5A is an enlarged, side schematic view of one embodiment of an end effector assembly showing relative movement of a first jaw member relative to a second jaw member prior to advancement of the knife through the end effector assembly;
• FIG. 5B is an enlarged, side schematic view of the end effector assembly showing relative movement of the knife through the end effector assembly to divide tissue;
• FIG. 5C is an enlarged, side schematic view of the end effector assembly showing relative movement of the knife extending from the distal end of the end effector assembly;
• FIG. 6A is an enlarged, side schematic view of another embodiment of an end effector assembly showing a first jaw member extending beyond a second jaw member;
• FIG. 6B is schematic view of another embodiment of an end effector assembly showing a series of electrical connections to a control switch and a generator to enable both bipolar activation and monopolar activation; and
• FIG. 6C is a table showing the various modes of operation of the forceps utilizing the end effector configuration ofFIG. 6B.
DETAILED DESCRIPTION
• Turning now toFIGS. 1A-1D, one embodiment of anendoscopic forceps10 is shown for use with various surgical procedures. For the purposes herein, a vessel sealing forceps is shown and described, however, it is envisioned that other types of forceps or scissors may be utilized which both treat tissue for cauterization, coagulation or other purposes and which may be configured for monopolar applications as described herein. Moreover, although the figure drawings depict aforceps10 for use in connection with endoscopic surgical procedures, the present disclosure may be used for more traditional open surgical procedures. For the purposes herein, theforceps10 is described in terms of an endoscopic instrument, however, it is contemplated that an open version of theforceps10 may also include the same or similar operating components and features as described below.
• Forceps10 generally includes ahousing20, ahandle assembly30, a rotatingassembly80, atrigger assembly70 and anend effector assembly100 which mutually cooperate to grasp, treat and divide tissue. For the purposes herein, thehandle assembly30, rotating assembly,trigger assembly70 andend effector assembly100 are only generally described. A more detailed explanation of all of these cooperating elements are described in commonly owned, co-pending U.S. patent application Ser. No. 10/460,926 the entire contents of which is hereby incorporated by reference herein.
• Forceps10 includes ashaft12 which has adistal end16 dimensioned to mechanically engage theend effector assembly100 and aproximal end14 which mechanically engages thehousing20. In the drawings and in the descriptions which follow, the term “proximal”, as is traditional, will refer to the end of theforceps10 which is closer to the user, while the term “distal” will refer to the end which is further from the user. Details of how theshaft12 connects to theend effector assembly100 and how the proximal end connects to thehousing20 are explained in the above-mentioned commonly owned, co-pending U.S. patent application Ser. No. 10/460,926.
• As best seen inFIG. 1A,forceps10 also includes anelectrosurgical cable310 which connects theforceps10 to a source of electrosurgical energy, e.g., agenerator300.Cable310 is internally divided into cable leads310a,310band310cwhich each transmit electrosurgical energy through their respective feed paths through theforceps10 to theend effector assembly100 as explained in more detail with respect to U.S. patent application Ser. No. 10/460,926. Preferably, generators such as those sold by Valleylab—a division of Tyco Healthcare LP, located in Boulder Colo. are used as a source of electrosurgical energy, e.g., FORCE EZ™ Electrosurgical Generator, FORCE FXM Electrosurgical Generator, FORCE 1C™ Electrosurgical Generator, FORCE 2™ Electrosurgical Generator, SurgiStat™ II Electrosurgical Generator. One such system is described in commonly-owned U.S. Pat. No. 6,033,399 the entire contents of which are hereby incorporated by reference herein. Other systems have been described in commonly-owned U.S. Pat. No. 6,187,003 the entire contents of which is also incorporated by reference herein.
• Preferably, thegenerator300 includes various safety and performance features including isolated output, independent activation of accessories. Preferably, theelectrosurgical generator300 includes Valleylab's Instant Response technology which provides an advanced feedback system to sense changes intissue 200 times per second and adjust voltage and current to maintain appropriate power.
• Handleassembly30 includes a fixedhandle50 and amovable handle40. Fixedhandle50 is integrally associated withhousing20 and handle40 is movable relative to fixedhandle50. Rotatingassembly80 is preferably integrally associated with thehousing20 and is rotatable approximately 180 degrees in either direction about a longitudinal axis “A”. Details of thehandle assembly30 and the rotatingassembly80 are described in more detail with respect to U.S. patent application Ser. No. 10/460,926.
• As mentioned above,end effector assembly100 is attached at thedistal end16 ofshaft12 and includes a pair of opposingjaw members110 and120.Movable handle40 ofhandle assembly30 is ultimately connected to an internally disposed drive assembly (not shown) which, together, mechanically cooperate to impart movement of thejaw members110 and120 from an open position wherein thejaw members110 and120 are disposed in spaced relation relative to one another, to a clamping or closed position wherein thejaw members110 and120 cooperate to grasp tissue therebetween.
• Turning now to the more detailed features of one embodiment of the present disclosure as described with respect toFIGS. 1A-3,movable handle40 includes anaperture42 defined therethrough which enables a user to grasp and move thehandle40 relative to the fixedhandle50. More particularly, handle40 is selectively moveable about a pivot (not shown) from a first position relative to fixedhandle50 to a second position in closer proximity to the fixedhandle50 which imparts movement of thejaw members110 and120 relative to one another.
• The lower end of themovable handle40 includes aflange90 which, upon movement of thehandle40 proximally, is reciprocated within fixedhandle50.Flange90 rides within a predefined channel (not shown) disposed within fixedhandle50 to lock themovable handle40 relative to the fixedhandle50.
• As best shown inFIG. 1C, a locking flange44 is disposed on the outer periphery of thehandle40 above the upper portion of thehandle40. Locking flange44 prevents thetrigger assembly70 from firing when thehandle40 is oriented in a non-actuated position, i.e., thejaw members110 and120 are open. As can be appreciated, this prevents accidental or premature severing of tissue prior to completion of a tissue seal.
• As explained in detail in co-pending U.S. patent application Ser. No. 10/460,926,movable handle40 is designed to provide a distinct mechanical advantage over conventional handle assemblies due to the unique position of the pivot point relative to the longitudinal axis “A” of theshaft12. In other words, by positioning the pivot point above the driving element, the user gains lever-like mechanical advantage to actuate thejaw members110 and120 enabling the user to close thejaw members110 and120 with lesser force while still generating the required forces necessary to effect a proper and effective tissue seal. It is also envisioned that the unilateral design of theend effector assembly100 will also increase mechanical advantage.
• As best seen inFIGS. 1A and 1D, theend effector assembly100 includes opposingjaw members110 and120 which cooperate to effectively grasp tissue for sealing purposes. Theend effector assembly100 is designed as a unilateral assembly, i.e.,jaw member120 is fixed relative to theshaft12 andjaw member110 pivots about apivot pin103 to grasp tissue.
• More particularly, the unilateralend effector assembly100 includes one stationary or fixedjaw member120 mounted in fixed relation to theshaft12 and pivotingjaw member110 mounted about apivot pin103 attached to thestationary jaw member120. Areciprocating sleeve60 is slidingly disposed within theshaft12 and is remotely operable by the drive assembly (not shown) which cooperates withhandle40 as explained above to open and close thejaw members110 and120. The pivotingjaw member110 includes a detent orprotrusion117 which extends fromjaw member110 through anaperture62 disposed within the reciprocating sleeve60 (FIG. 1D). The pivotingjaw member110 is actuated by sliding thesleeve60 axially within theshaft12 such thataperture62 abuts against thedetent117 on the pivotingjaw member110. Pulling thesleeve60 proximally closes thejaw members110 and120 about tissue grasped therebetween and pushing thesleeve60 distally opens thejaw members110 and120 for approximating and grasping purposes.
• Once actuated, handle40 moves in a generally arcuate fashion towards fixedhandle50 about the pivot point which forces the driving flange (not shown) proximally against the drive assembly (not shown) which, in turn, pulls reciprocatingsleeve60 in a generally proximal direction to closejaw member110 relative tojaw member120. Moreover, proximal rotation of thehandle40 causes the locking flange44 to release, i.e., “unlock” thetrigger assembly70 for selective actuation. These features are shown and explained in detail with reference to commonly-owned, co-pending U.S. application Ser. No. 10/460,926.
• As best illustrated inFIGS. 5A-5C, aknife channel115aand115bruns through the center of thejaw members110 and120, respectively, such that ablade185 can cut tissue grasped between thejaw members110 and120 when thejaw members110 and120 are in a closed position. More particularly, theblade185 can only be advanced through the tissue when thejaw members110 and120 are closed thus preventing accidental or premature activation of theblade185 through tissue. Put simply, the knife channel115 (made up ofhalf channels115aand115b) is blocked when thejaws members110 and120 are opened and aligned for distal activation when thejaw members110 and120 are closed.
• As best shown inFIG. 1D,jaw member110 includes ajaw housing116 which has an insulative substrate orinsulator114 and an electricallyconducive surface112.Insulator114 is preferably dimensioned to securely engage the electricallyconductive sealing surface112. This may be accomplished by stamping, by overmolding, by overmolding a stamped electrically conductive sealing plate, by overmolding a metal injection molded seal plate and/or other ways known in the art. It is envisioned atrigger lead311 fromswitch200 electrically connects to theseal plate112.
• All of these manufacturing techniques producejaw member110 having an electricallyconductive surface112 which is substantially surrounded by an insulatingsubstrate114. Theinsulator114, electricallyconductive sealing surface112 and the outer,non-conductive jaw housing116 are preferably dimensioned to limit and/or reduce many of the known undesirable effects related to tissue sealing, e.g., flashover, thermal spread and stray current dissipation.
• As best seen inFIG. 1D,jaw member110 also includes apivot flange118 which includesprotrusion117.Protrusion117 extends frompivot flange118 and includes an arcuately-shaped inner surface dimensioned to matingly engage theaperture62 ofsleeve60 upon retraction thereof.Pivot flange118 is also dimensioned to engagepivot pin103 to allowjaw member110 to rotate relative tojaw member120 upon retraction of thereciprocating sleeve60.Pivot pin103 also mounts to thestationary jaw member120 within a proximal portion ofjaw member120.
• Preferably, the electricallyconductive surface112 and theinsulator114, when assembled, form the longitudinally-orientedknife slot115adefined therethrough for reciprocation of theknife blade185. As mentioned above,knife channel115acooperates with corresponding knife channel115bdefined instationary jaw member120 to facilitate longitudinal translation of theknife blade185 along a preferred cutting plane to effectively and accurately separate tissue along the formed tissue seal.
• Jaw member120 includes similar elements tojaw member110 such asjaw housing126 having aninsulator124 and an electricallyconductive sealing surface122 which is dimensioned to securely engage theinsulator124. Likewise, the electricallyconductive surface122 and theinsulator124, when assembled, include longitudinally-oriented channel115bdefined therethrough for reciprocation of theknife blade185. As mentioned above, when thejaw members110 and120 are closed about tissue420,knife channels115aand115bform acomplete knife channel115 to allow longitudinal translation of theknife185 in a distal fashion to sever tissue along the tissue seal.
• As mentioned above,jaw member120 may include a series of stop members150a-150cpreferably disposed on the inner facing surfaces of the electricallyconductive sealing surface122 to facilitate gripping and manipulation of tissue and to define a gap “G” (FIG. 5A) between opposingjaw members110 and120 during sealing and cutting of tissue. It is envisioned that the series of stop members150a-150cmay be employed on one or bothjaw members110 and120 depending upon a particular purpose or to achieve a desired result. A detailed discussion of these and other envisioned stop members150a-150cas well as various manufacturing and assembling processes for attaching and/or affixing the stop members150a-150cto the electrically conductive sealing surfaces112,122 are described in commonly-assigned, co-pending U.S. Application Serial No. PCT/US01/11413 which is hereby incorporated by reference in its entirety herein.
• Jaw member120 is designed to be fixed to the end of a rotating tube (not shown) which is part of the rotatingassembly80 such that rotation of the tube will impart rotation to theend effector assembly100.Jaw member120 is connected to a second electrical potential through the rotating tube (not shown) which is connected at its proximal end to a lead310cfromcable310. Details relating to the mechanical and electromechanical engagement of thejaw member120 to the rotatingassembly80 are described in above-mentioned, commonly-owned, co-pending U.S. patent application Ser. No. 10/460,926.
• As mentioned above, thejaw members110 and120 may be opened, closed and rotated to manipulate tissue until sealing is desired. This enables the user to position and re-position theforceps10 prior to activation and sealing. As illustrated inFIG. 1A, theend effector assembly100 is rotatable about longitudinal axis “A” through rotation of the rotatingassembly80. It is envisioned that the unique feed path of thetrigger lead311 from theswitch200 through the rotatingassembly80, alongshaft12 and, ultimately, to thejaw member110 enables the user to rotate theend effector assembly100 about 180 degrees in both the clockwise and counterclockwise direction without tangling or causing undue strain on the cable lead. Theother cable lead310cfromcable310 is fused or clipped to the proximal end of the rotating tube (not shown) and is generally unaffected by rotation of thejaw members110 and120. As can be appreciated, this facilitates the grasping and manipulation of tissue.
• Again as best shown inFIGS. 1A and 1C,trigger assembly70 mounts atopmovable handle40 and cooperates with the knife assembly180 (FIGS. 2,3,4, and5A-5C) to selectively translateknife185 through a tissue seal. More particularly, thetrigger assembly70 includes afinger actuator71 and apivot pin73 which mounts thetrigger assembly70 to thehousing20.Finger actuator71 is dimensioned to abut the locking flange44 onhandle40 when thehandle40 is disposed in a non-actuated position, i.e., thejaw members110 and120 are opened.
• Thetrigger assembly70 is designed to cooperate with adrive bar64 which connects to theknife assembly180. Proximal activation of thefinger actuator71 rotates thetrigger assembly70 aboutpivot pin73 which, in turn, forces thedrive bar64 distally, which ultimately extends theknife185 through tissue. A spring (not shown) may be employed to bias theknife assembly180 in a retracted position such that after severing tissue theknife185 and theknife assembly180 are automatically returned to a pre-firing position. In addition, when thehandle40 is actuated andflange90 is fully reciprocated within fixedhandle50, the locking flange44 moves proximally allowing activation of thetrigger assembly70.
• As best shown inFIG. 1A, thecable310 is fed through the bottom of thehousing20 through fixedhandle50. Afirst lead310cextends directly fromcable310 into the rotatingassembly80 and connects (via a fused clip or spring clip or the like) totube60 to conduct the second electrical potential to fixedjaw member120. Second andthird leads310aand310bextend fromcable310 and connect to the hand switch or joy-stick-like toggle switch200. Switch200 permits the user to selectively activate theforceps10 in a variety of different orientations, i.e., multi-oriented activation which simplifies activation. When theswitch200 is depressed, atrigger lead311 carries the first electrical potential tojaw member110. More particularly, thetrigger lead311 extends fromswitch200 through the rotatingassembly80 and along the upper portion of the rotating tube (not shown) and eventually connects to themovable jaw member110. As can be appreciated, locating theswitch200 on theforceps10 has many advantages. For example, theswitch200 reduces the amount of electrical cable in the operating room and eliminates the possibility of activating the wrong instrument during a surgical procedure due to “line-of-sight” activation.
• As explained in detail above, the second electrical potential (i.e., lead310c) is conducted tojaw member120 through the rotating tube. The two potentials are preferably isolated from one another by insulative sheathing (or the like) which surrounds the trigger lead. Preferably, thejaw members110 and120 are electrically isolated from one another such that bipolar electrosurgical energy can be effectively transferred through the tissue to form a tissue seal.
• Once the desired position for the sealing site is determined and thejaw members110 and120 are properly positioned, handle40 may be compressed fully such that theflange90 is reciprocated and locked within fixedhandle50.Handle40 is now secured in position relative to fixedhandle50 which, in turn, locks thejaw members110 and120 in a closed position about tissue. Theforceps10 is now ready for selective application of electrosurgical energy and subsequent separation of tissue, i.e., whenmovable handle10 reciprocates within fixedhandle50, locking flange44 moves into a position to permit activation of thetrigger assembly70 as explained above.
• As can be appreciated, the combination of the mechanical advantage of the over-the-center pivot along with the assisting compressive forces associated with a compression spring (not shown) facilitate and assure consistent, uniform and accurate closure pressure about tissue within the desired working pressure range of about 3 kg/cm²to about 16 kg/cm²and, preferably about 7 kg/cm²to about 13 kg/cm². As mentioned above, at least one jaw member, e.g.,120, may include a stop member e.g.,150a, which limits the movement of the two opposingjaw members110 and120 relative to one another. Preferably, a series of stop members are to yield a consistent and accurate gap distance “G” during sealing (FIG. 5A) which ranges from about 0.001 inches to about 0.006 inches and, more preferably, between about 0.002 and about 0.003 inches. By controlling the intensity, frequency and duration of the electrosurgical energy applied to the tissue, the user can effectively seal the tissue along a predetermined tissue site.
• As energy is being selectively transferred to theend effector assembly100, across thejaw members110 and120 and through the tissue, a tissue seal forms isolating two tissue halves. At this point and with other known vessel sealing instruments, the user must remove and replace theforceps10 with a cutting instrument (not shown) to divide the tissue halves along the tissue seal which is both time consuming and tedious and may result in inaccurate tissue division across the tissue seal due to misalignment or misplacement of the cutting instrument along the ideal tissue cutting plane.
• The present disclosure incorporatesknife assembly180 which, when activated via thetrigger assembly70, progressively and selectively divides the tissue along an ideal tissue plane in precise manner to effectively and reliably divide the tissue. Theknife assembly180 allows the user to quickly separate the tissue immediately after sealing without substituting a cutting instrument through a cannula or trocar port. As can be appreciated, accurate sealing and dividing of tissue is accomplished with thesame forceps10.
• Once the tissue is divided into tissue halves, thejaw members110 and120 may be opened by re-grasping thehandle40 which release theflange90 from fixedhandle50. Details relating to the releasing of the flange from handle are described in commonly-owned, co-pending U.S. application Ser. No. 10/460,926.
• Turning now to the operating characteristics of the present disclosure and as seen in the majority of the figures,forceps10 is designed for both bipolar electrosurgical treatment of tissue (either by vessel sealing as described above or coagulation or cauterization with other similar instruments) and monopolar treatment of tissue. For example,FIGS. 1A-D and2-4 show one embodiment of aforceps10 which includes amonopolar element154 which may be selectively extended and selectively activated to treat tissue.FIGS. 5A-5C show an alternate embodiment of the present disclosure which shows that theknife185 maybe extended from the distal end of theend effector assembly100 and selectively energized to treat tissue in a monopolar fashion.FIG. 6A shows another embodiment wherein thebottom jaw member120′ extends distally from thetop jaw member110′ to allow the surgeon to selectively energize thebottom jaw member120′ and treat tissue in a monopolar fashion.FIG. 6B shows yet another embodiment wherein thejaw members110″ and120″ include tapered distal ends which are selectively energized with a single electrical potential to treat tissue in a monopolar fashion.
• FIGS. 1A-1D and2-4 show one embodiment wherein amonopolar element154 is housed for selective extension within one jaw member, e.g.,jaw member120, of theend effector assembly100. More particularly,monopolar element154 is designed to move independently fromknife assembly180 and may be extended by further proximal movement of the trigger assembly70 (FIGS. 1A,2 and3) or by a separate actuator450 (FIG. 4).
• Preferably, themonopolar element154 is connected to areciprocating rod65 which extends through anelongated notch13 in the outer periphery of theshaft12 as best seen inFIG. 1B. Driverod60 which actuates theknife185 extends through the inner periphery ofshaft12. In order to extend themonopolar element154, thejaw members110 and120 are initially closed and theknife185 is advanced distally utilizing the trigger assembly70 (SeeFIG. 2). As best shown inFIG. 1C, thetrigger71 is initially advanced to translate theknife185 distally to cut through tissue, i.e., the “cut” stage (shown in phantom). Thereafter and as shown inFIG. 3, thetrigger71 may be further actuated in a proximal direction to extend themonopolar element154, i.e., the “extend” stage (shown in phantom).
• It is envisioned that thetrigger assembly70 may be designed such that themonopolar element154 may be extended when thejaw members110 and120 are in the open position. For example, thetrigger71 may be moved distally (or upwardly) from its original, rested, neutral or pre-actuated position to advance themonopolar element154. Alternatively, themonopolar element154 may be advanced irrespective of the orientation of thejaw members110 and120. For example, thetrigger assembly70 could be designed such that the it can be moved laterally (i.e., perpendicular to the longitudinal axis “A”) to advance themonopolar element154 or thetrigger assembly70 could be designed such that themonopolar element154 is extendible when thetrigger71 is moved to a proximal-most position (i.e., past the “cut” position as described above) and/or when thetrigger71 is advanced distally from the neutral or pre-actuated orientation. A return spring (not shown) may be included to return themonopolar element154 to a non-extended position upon release of thetrigger71.
• Upon extension of themonopolar element154, thegenerator300 is preferably configured to automatically switch theforceps10 from a bipolar activation mode (i.e., deactivating energy delivery tojaw members110 and120) to a monopolar activation mode (i.e., activating the monopolar element154). As can be appreciated, theforceps10 may also (or alternatively) be configured for manual switching between the bipolar activation mode and the monopolar activation mode.
• As described above, when theforceps10 is configured for bipolar operation, the activation ofswitch200 transfers energy fromjaw member110 through the tissue and tojaw member120 to treat tissue. In the monopolar mode, activation of switch200 (or a separate switch, e.g., a footswitch), transfers energy to themonopolar element154, through the tissue and to areturn electrode550, e.g., a return pad, placed adjacent to or in contact with the patient. The monopolar activation mode allows themonopolar element154 to quickly treat avascular tissue structures and/or quickly dissect narrow tissue planes.
• As can be appreciated, it is also envisioned that thetrigger assembly70 may be electrically configured to transmit electrical energy to themonopolar element154 when extended. For example, thetrigger assembly70 may be configured such that proximal-most actuation of the trigger71 (FIG. 1C) both extends and activates themonopolar element154. An automatic safety circuit460 (or mechanical safety lock (not shown)) may be employed which prevents theswitch200 from energizing thejaw members110 and120 when themonopolar element154 is extended.
• FIG. 4 shows another embodiment of the present disclosure wherein themonopolar element154 is selectively extendible utilizing asecond actuator450. As described above, theknife185 is advanced by actuating thetrigger71 in a generally proximal direction. Themonopolar element154 is selectively advanceable independently of theknife185 and may be extended when thejaw members110 and120 are disposed in either the open configuration or closed configuration. It is envisioned that theactuator450 may be electrically configured to activate themonopolar element154 automatically once extended or manually byactivation switch200 or perhaps another switch (not shown). As mentioned above, asafety circuit460 may be employed to deactivatejaw members110 and120 when themonopolar element154 is extended such that activation of theswitch200 energizes themonopolar element154. In the case of a separate activation switch for the monopolar element, the safety circuit would deactivate theswitch200.
• FIG. 5A-5C show an alternate embodiment of the present disclosure wherein theknife185 can be extended distally beyond thejaw members110 and120 and separately energized to treat tissue. In this instance, when the knife is extended beyond thejaw members110 and120, theknife185 becomes the monopolar element.
• For example and as depicted in the activation sequence shown inFIGS. 5A-5C, theknife185 is initially seated in a neutral position during tissue approximation and grasping and during the sealing process. Once thejaw members110 and120 are closed about tissue, the elongated knife channel115 (defined by upper andlower knife channels115aand115b, respectively) is formed to allow selective translation of theknife185 through tissue disposed between thejaw members110 and120. Upon actuation of thetrigger71, theknife bar64 forces theknife185 distally through the tissue to the distal end of theknife channel115. Astop119 is included to temporarily limit the movement of theknife185 and provide the user with positive tactile feedback as to the end of the cutting stroke. Upon further actuation of thetrigger71, theknife185 overcomes the limiting forces associated with thestop119 and is forced by the knife bar to further extend out of theknife channel115 and beyond the distal ends of thejaw members110 and120.
• It is envisioned that once theknife185 extends beyond thejaw members110 and120, a safety or switch deactivates energizing circuitry to thejaw members110 and120 and activates the energizing circuitry to theknife185 such that activation of theswitch200 energizes theknife185 and the jaw members remain neutral. For example, thestop119 may act as a safety switch such that upon being forced by theknife185 out of or away from theknife channel115, thestop119 deactivates circuitry to thejaw members110 and120 and activates circuitry to themonopolar knife185 and thereturn electrode550. Aseparate lead69 may be used to electrically communicate with thegenerator300. As can be appreciated, theknife185 may now be used in a monopolar fashion to treat tissue.
• Upon release of thetrigger71, theknife185 automatically retracts into theknife channel115 and back to the pre-actuated position as shown inFIG. 5A. At the same time thestop119 reverts to its original position to temporarily block theknife channel115 for subsequent actuation.
• FIG. 6A shows another embodiment of aforceps10′ according to the present disclosure wherein thelower jaw member120′ is designed to extend beyond the distal end ofjaw member110′. In order to switch from a bipolar mode of the operation to a monopolar mode, the surgeon activates a switch or control which energizesjaw member120′ to a first potential and activates areturn pad550 to a second potential. Energy is transferred fromjaw member120, through tissue, and to thereturn pad550 to treat tissue. The distal end ofjaw member120′ acts as the monopolar element for treating the tissue and may be shaped accordingly to enhance electrosurgical effect.
• FIG. 6B shows yet another schematic embodiment of aforceps10″ according to the present disclosure wherein the distal ends of bothjaw members110 and120 are shaped to treat tissue when disposed in a monopolar mode. More particularly, thedistal tips112a″ and122a″ are preferably elongated or tapered to enhance energy delivery when theforceps10″ is disposed in the monopolar mode. When disposed in the bipolar mode, the tapered ends112a″ and122a″ do not effect treating tissue between electricallyconductive plates112″ and122″.
• Acontrol switch500 is preferably included which regulates the transition between bipolar mode and monopolar mode.Control switch500 is connected togenerator300 viacables360 and370. A series ofleads510,520 and530 are connected to thejaw members110,120 and thereturn electrode550, respectively. As best shown in the table depicted inFIG. 6C, each lead510,520, and530 is provided with an electrical potential or remains neutral depending upon the particular “mode” of theforceps10″. For example, in the bipolar mode, lead510 (and, in turn,jaw member110″) is energized with a first electrical potential and lead520 (and, in turn,jaw member120″) is energized with second electrical potential. As a result thereof, electrosurgical energy is transferred fromjaw member110″ through the tissue and tojaw member120″. Thereturn electrode550 remains off or neutral.
• In a monopolar mode,jaw member110″ and120″ are both energized with the same electrical potential and thereturn pad550 is energized with a second electrical potential forcing the electrical current to travel from thejaw members110″ and120″, through the tissue and to thereturn electrode550. This enables thejaw members110″ and120″ to treat tissue in a monopolar fashion which, as mentioned above, advantageously treats avascular tissue structures and/or allows quick dissection of narrow tissue planes. As can be appreciated, all of theleads510,520 and530 may be deactivated when theforceps10″ is turned off or idle.
• Although the general operating components and inter-cooperating relationships among these components have been generally described with respect to avessel sealing forceps10, other instruments may also be utilized which can be configured to allow a surgeon to selectively treat tissue in both a bipolar and monopolar fashion. For example, bipolar grasping and coagulating instruments, cauterizing instruments, bipolar scissors, etc.
• The present disclosure also relates to a method for treating tissue with electrosurgical energy from theelectrosurgical generator300 which includes the steps of: providing anendoscopic forceps10 including ahousing20 having ashaft12 affixed thereto. Theshaft12 includes first and second jaw members,110 and120, respectively, attached to a distal end of theshaft12. An actuator or handleassembly30 is included for movingjaw members110 and120 relative to one another from a first position wherein thejaw members110 and120 are disposed in spaced relation relative to one another to a second position wherein thejaw members110 and120 cooperate to grasp tissue therebetween. Amonopolar element154 is also included which is housed within at least thefirst jaw member120 and selectively movable from a first position within thefirst jaw member120 to a second position distal to thefirst jaw member120. Areturn electrode550 is provided and placed in contact with patient tissue.
• The method also includes the steps of: connecting to eachjaw member110 and120, themonopolar element154 and thereturn electrode550 to theelectrosurgical generator300; grasping tissue between thejaw members110 and120; selectively activating thejaw members110 and120 to treat tissue disposed between thejaw members110 and120 in a bipolar fashion; and selectively activating themonopolar element154 and thereturn electrode550 independent of thejaw members110 and120 to treat tissue in a monopolar fashion.
• Preferably, after the step of selectively activating thejaw members110 and120 to treat tissue, the method includes the step of: extending themonopolar element154 from the distal end of thejaw members110 and120. Advantageously, the step of selectively activating themonopolar element154 includes deactivating thejaw members110 and120.
• After the step of selectively activating thejaw members110 and120 to treat tissue, the method may include the step of: releasing the tissue from thejaw members110 and120.
• From the foregoing and with reference to the various figure drawings, those skilled in the art will appreciate that certain modifications can also be made to the present disclosure without departing from the scope of the same. For example, it may be preferable to add other features to theforceps10, e.g., an articulating assembly to axially displace theend effector assembly100 relative to theelongated shaft12.
• It is envisioned that theforceps10 may be designed such that it is fully or partially disposable depending upon a particular purpose or to achieve a particular result. For example,end effector assembly100 may be selectively and releasably engageable with thedistal end16 of theshaft12 and/or theproximal end14 ofshaft12 may be selectively and releasably engageable with thehousing20 and thehandle assembly30. In either of these two instances, theforceps10 would be considered “partially disposable” or “reposable”, i.e., a new or different end effector assembly100 (or endeffector assembly100 and shaft12) selectively replaces the oldend effector assembly100 as needed. As can be appreciated, the presently disclosed electrical connections would have to be altered to modify the instrument to a reposable forceps.
• Moreover, it is envisioned that theswitch200 may be decommissioned during the cutting process. Decommissioning theswitch200 when thetrigger71 is actuated eliminates unintentionally activating the forceps during the cutting process. It is also envisioned that theswitch200 may be disposed on another part of theforceps10, e.g., the fixedhandle40, rotatingassembly80,housing20, etc.
• While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.

Claims (11)

1. An endoscopic forceps, comprising:

a housing having a shaft affixed thereto, the shaft including first and second jaw members attached to a distal end thereof, each jaw member adapted to connect to a source of electrosurgical energy such that the jaw members are selectively capable of operating in a bipolar mode which enables the jaw members to conduct bipolar energy through tissue held therebetween to treat tissue;

a first actuator operably associated with the housing which moves the jaw members relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween;

a monopolar element housed within at least the first jaw member and selectively movable from a first position within the first jaw member to a second position distal to the first jaw member, the monopolar element being adapted to connect to the source of electrosurgical energy and being selectively activatable independent of the jaw members; and

a second actuator operatively coupled to the housing which operates to extend the monopolar element from the first position within the first jaw member to the second position distal to the first jaw member.

2. An endoscopic forceps according toclaim 1 wherein the monopolar element includes a sharpened cutting edge.

3. An endoscopic forceps according toclaim 1 wherein the forceps includes a knife which is selectively moveable within a knife channel defined within at least one of the first and second jaw members to cut tissue disposed between the first and second jaw members.

4. An endoscopic forceps according toclaim 1 wherein the forceps is a vessel sealing forceps and at least one of the jaw members includes at least one non-conductive stop member disposed thereon which controls the distance between the first and second jaw members when tissue is held therebetween.

5. An endoscopic forceps according toclaim 1 wherein the monopolar element is a knife which is selectively moveable within a knife channel defined within at least one of the first and second jaw members to initially cut tissue disposed between the first and second jaw members and subsequently extend distally from the jaw members, the knife being energized to treat tissue in a monopolar fashion.

6. An endoscopic forceps according toclaim 5 wherein the knife includes a safety which only allows electrical activation of the knife when the knife is extended from the distal ends of the jaw members.

7. An endoscopic forceps according toclaim 3 further comprising a trigger operably associated with the housing which operates to both move the knife to divide tissue disposed between the jaw members and to extend the monopolar element from the first position within the first jaw member to the second position distal to the first jaw member.

8. An endoscopic forceps, comprising:

a housing having a shaft affixed thereto, the shaft including first and second jaw members attached to a distal end thereof, the first jaw member extending distally relative to the second jaw member, each jaw member adapted to connect to a source of electrosurgical energy such that the jaw members are selectively capable of operating in a bipolar mode which enables the jaw members to conduct bipolar energy through tissue held therebetween to treat tissue;

an actuator operably coupled to the housing which moves jaw members relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween; and

a control switch adapted to operably communicate with the source of electrosurgical energy which, upon selective activation thereof, deactivates the second jaw member and activates the first jaw member with a first electrical potential a return electrode with a different electrical potential to enable the first jaw member to selectively treat tissue in a monopolar fashion.

9. An endoscopic forceps according toclaim 8 wherein the forceps includes a safety which only allows electrical activation of the control switch when the jaw members are disposed in the second position.

10. An endoscopic forceps, comprising:

a housing having a shaft affixed thereto, the shaft including first and second jaw members attached to a distal end thereof, the first and second jaw members each including a tapered distal end, each jaw member adapted to connect to a source of electrosurgical energy such that the jaw members are selectively capable of operating in a bipolar mode which enables the jaw members to conduct bipolar energy through tissue held therebetween to treat tissue

an actuator operably associated with the housing which moves the jaw members relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween; and

a control switch adapted to operably communicate with the source of electrosurgical energy which, upon selective activation thereof activates the first jaw member and the second jaw member with a first electrical potential, the control switch also activating a return electrode with a different electrical potential which enables the first and second jaw members to selectively treat tissue in a monopolar fashion.

11. An endoscopic forceps according toclaim 10 wherein the forceps includes a safety which only allows electrical activation of the control switch when the jaw members are disposed in the second position.

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